Thyroid nodules with indeterminate cytology: molecular imaging with 99mTc-methoxyisobutylisonitrile (MIBI) is more cost-effective than the Afirma® gene expression classifier

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Abstract
To compare the cost-effectiveness of 99mTc-methoxyisobutylisonitrile (MIBI) thyroid scintigraphy and the Afirma® gene expression classifier for the assessment of cytologically indeterminate thyroid nodules. A decision tree model was used. Costs were calculated from the perspective of the German health insurance system. The robustness of the results was assessed with probabilistic sensitivity analyses using a Monte Carlo simulation. Life expectancy was 34.3 years (estimated costs per patient €1,459 – €2,224) for the MIBI scan and 34.1 years (estimated costs €3,560 – €4,071) for the molecular test. These results were confirmed by the Monte Carlo simulation. MIBI thyroid scintigraphy is more cost-effective than the gene expression classifier.

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